The effect of drilling speed on implant stability and postoperative pain levels‐ a randomized controlled clinical trial

Background It was previously demonstrated that drilling speed during implant osteotomy may affect the final outcome of implant surgery. Aim/Hypothesis The aim of the present study was to compare the level of discomfort during surgery, postoperative pain levels and implant stability after implant site preparation either with 50 rpm low-speed drilling without irrigation or 800 rpm high-speed drilling with irrigation Materials and Methods Fifteen patients (8 males and 7 females, mean age ± std- 38 ± 15) with bilateral missing mandibular first molars were included in the study. Each site was randomly assigned either in Test Group (50 rpm without irrigation) or in Control Group (800 rpm with irrigation). A full thickness flap was elevated, and drilling protocol depending on the group was performed. A standard sized implant and a healing abutment were installed in both groups during the same surgery. The implant stability was measured at baseline, 1,2 and 3 months postoperatively using resonance frequency analysis (RFA), dimensional changes in hard tissues were evaluated at baseline and 3 months using standardized periapical radiographs, pulp vitality of the adjacent teeth in the implant area was measured at baseline, 1 and 3 months, keratinized tissue width was measured at baseline and 3 month, discomfort levels were evaluated during the surgery and pain levels during the first week of healing using a VAS scale. Results Keratinized tissue width was similar in both groups at baseline and 3 months, but a significant difference was found in intragroup comparisons for both groups (P < 0.01 for both). RFA and vitality values did not reveal any difference both within and between groups comparisons during the follow-up. First bone to implant contact (fBIC) was significantly lower in both groups at 3rd month compared to baseline (P < 0.01 for Test Group, P = 0.01 for Control Group). Marginal bone level changes were similar in both groups. The discomfort levels during surgery did not reveal any difference between groups. However, postoperative pain level was significantly higher in the Test group at 2nd day (P < 0.05). Postoperative pain level in the Test and Control groups were significantly higher in the first day than 6,7 Days and 5,6,7 days, respectively (P < 0.05). Conclusion and Clinical Implications Based on the results of the present study, it can be concluded that both drilling protocols are safe for implant site preparation and there seems to be a slight advantage in favor of high-speed drilling in terms of pain perception after surgery. However, this difference seems to be clinically irrelevant.